That's an interesting question. I guess the question is what one is appealing. Is one appealing that the CDR got the science wrong? The CMA reps have almost been implying that the science is going to be clear-cut, and it ain't. Sometimes it's really clear-cut that a drug is fantastically effective and safe. Other times it's clear-cut that it's not. And a whole bunch of times we don't know. We don't know how this drug is going to work in the real world, because Health Canada only needs six months of data and this antidepressant is used for six years, etc. I want to make that point, that science isn't going to solve all this.
There's a values process, which is why I personally pushed very hard to add public members to the CEDAC committee. I thought it was really important to have. We can argue whether two may not be enough and whatever.
So there's the science part and there's a values part. Is this drug really good enough value for money to justify putting on the formulary, given the other things we could spend health care dollars on?
I would agree that in general it would be reasonable to appeal to another body, but you would want to appeal to another body that's using the same principles as CEDAC uses. My understanding is that Hungary does that; they have a second group that hears appeals that is similarly constituted to their first group.